When I first read about neurosyphilis in medical school, I became convinced that Mrs. Thatcher, who I detested intensely because it was fashionable detesting her, had general paralysis of the insane. The condition, marked by episodic bouts of temporary insanity, which indicated that the spirochetes were feasting on expensive real estate in the brain, seemed a plausible explanation why she had introduced the poll tax.
A little bit of medical knowledge can lead to tomfoolery by the juvenile. I began diagnosing the powerful with medical conditions. I thought the former leader of the Labour Party, Neil Kinnock, who had an odd affect, was both hyperthyroid and hypothyroid — when he spoke he looked myxedematous, and when was silent he looked like he had Grave’s disease. The tacit, but not silent enough, Prince Charles spoke in a tone that seemed a cry for help for acutely thrombosed piles. I also realized that the Prince of Wales — who is the most compelling evidence for the magical kingdom of elves — wasn’t reducible to a single diagnostic code. Diagnosing Hillary was relatively straightforward. After reading a third of her memoirs, which permanently cured my insomnia, I felt someone had inadvertently given her dextrose without thiamine.
There’s something delightfully empowering, and annoyingly juvenile, about diagnosing the famous with medical conditions. It is also strangely pedagogic. I’ll never forget the symptoms of syphilis, not because I’ve seen patients with them (nor because I have them), but because I’ve templated these symptoms on people who almost certainly don’t suffer from syphilis.
Thus, it’s no surprise that many are keen to diagnose Mr. Trump with a medical condition — my preferred diagnosis would be Klüver–Bucy syndrome, but that would expose my juvenile intent. Far removed from childish diagnostic name calling, many serious people seriously believe that Mr. Trump has a neurocognitive condition which is seriously impairing his judgment and decision making.
Analyzing Trump’s speech pattern, experts have questioned what his decline of verbal fluency indicates. Possibly mild cognitive impairment (MCI)? Possibly the first signal of dementia? Possibly normal aging? STAT outlines the evidence. STAT has gallantly fought overdiagnosis and overmedicalization. MCI is the mother of overdiagnosed conditions — it’s more capacious than the Pacific Ocean — technically anyone can have it on a bad day, or after opening the 2nd bottle of wine. I hope STAT will do an expose of physician-industry relationships which have led to overdiagnosis of MCI.
That even Mr. Findlay, a serious journalist with hardly the juvenile disposition that I possess in abundance, has fallen for the medicalization of Trump, begs the question — what gives?
There is, of course, a historical curiosity how pain and disease influence a person’s worldview. Thoreau once said that nothing drives a revolution more forcefully than a man with unfulfilled bowels. Many historians believe that Karl Marx’s hidradenitis suppurativa — painful inflammation of the sweat glands — made him angry about capitalism. Which means that the Bolshevik revolution was conceived, not by the events of Bloody Sunday, but under the smelly arm pits of an unkept Nineteenth Century Londoner.
The analysis of Trump is not historical but in the present and Mr. Trump is certainly no Karl Marx. Even so, there’s little precedence for medicalizing POTUS because of their policies. When Bush Jr. alluded that he spoke to God, no one tried diagnosing him with temporal lobe epilepsy. Even Bill Clinton, the man who once put a preposition on trial, escaped the wrath of DSM.
Why, then, are people so obsessed with giving Mr. Trump an ICD-10 or DSM-5 code?
Many readers will say that conflating Mr. Trump with the flawed, yet genuine leaders that I’ve mentioned is moral relativism. And I’d agree. The Iron Lady was no follower. Bill had several leadership moments, even when he wasn’t alone. Even Bush rose to the occasion — he rose to other occasions when the world might have been better off if he stayed sitting. Even the reptilian Hillary would, arguably, have been more of a leader than the comically bumbling Trump.
The comically bumbling Trump who could, in a parallel universe, be auditioning for the next Austin Powers, and who seems not to be enjoying his presidency terribly, is the heart of the problem. There’s an incessant attempt at delegitimizing Trump. It was never enough saying “Trump is a joke.” And “Trump is evil” no longer suffices – even though the look on the Pope’s face, when he stood next to Trump resembled the look on Gregory Peck’s face when he saw that his adopted son, Damian, had “666” written on his scalp.
The medicalization of Trump is part of an emerging phenomenon, thus far innominate, which I’ll call “rational delegitimization,” in which scholars, incredulous of Trump’s behavior, seek biological substrates to delegitimize him. It is an extension of the very legitimate and necessary legitimization of variation we like when we find that the variation has a biological explanation. But this is a very slippery slope.
Researchers have tried to show that conservatives and progressives have different brain structures — apparently, progressives have a larger anterior cingulate gyrus and conservatives have a larger amygdala. I’ll let you guess the abundance of which structure is more desirable.
This type of research can ossify polarization permanently. Already, many believe that their moral high ground shuts debate with opposing worldviews. The last thing you want is for people to believe they have not just the moral, but biological high ground. Tying biology with morality breeds a new class of biological theocrats who make the Ayatollah a libertarian, free love-seeking, cannabis smoker in comparison. Combining tribalism, functional MRI and p <0.05 can spit out BS of a scale one struggles to comprehend.
A colleague of mine hasn’t been herself for a few months. I often put academic blues to the promotion cycle, but she has already made associate professor. So, I inquired. With eyes swelling with genuine tears she told me that she was very upset that many “normal” (the air quotes are hers, not mine) people voted Trump.
This gets to the crux of the issue, which is our inability to grasp the broad coastline of what is normal (note absence of air quotes). I said to my colleague, as diplomatically as I could, that she needs to expand her definition of normal – actually, I said she needs to get out more.
It is normal for normal people to disagree about the least worst presidential candidate in 2016. It is normal for normal people to ask of those who disagree with them “how could you be so stupid?” It is normal, though worrying, to shrink the real estate of legitimacy by safe spaces. This is called “having an opinion,” which is what sets us apart from other mammals, notably the duck-billed platypus and, mercifully, the sheep.
The presence or absence of a disease, organic or psychiatric, is conditionally independent of whether someone agrees or disagree with your worldview. To seek biological substrates to delegitimize opposing views risks delegitimizing the already precarious medical sciences. Ideally, normal people politely agree to disagree, but even when they don’t, they’re still normal.
Mr. Trump has a condition which is very prevalent in our society and under diagnosed in 1600 Pennsylvania Avenue. It’s called “ineptness.” It doesn’t have an ICD code, yet. Which is just as well, because if ineptness became a preexisting condition, all insurance markets will truly enter an inept death spiral.
History will tell us if Mr. Trump had an unprecedented or, as he put it, “unpresidented” level of ineptness. But even if he does that doesn’t make him diseased. Normal can be aesthetically pleasing, or distasteful. And, for all his faults, and there surely are many, and notwithstanding #covfefe, Trump is probably normal.
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